ABSTRACT
The patient has had a large portion of her terminal ileum resected as a result of Crohn disease. She has had more than 100 cm removed, increasing her risk of bile acid depletion and subsequent steatorrhea, which she is demonstrating clinically. This excess of unabsorbed free fatty acids binds dietary calcium, which under normal conditions prevents excess oxalate absorption. Excess absorption leads to the formation of oxalate kidney stones. A low-fat diet and calcium supplementation with meals can help reduce the absorption of oxalate. In patients with less than 100 cm of small bowel resected, the primary cause of diarrhea is excess bile acids (more than what the small bowel can absorb), thus leading to bile acid-induced irritation of the colon and resultant diarrhea.
